左锁骨下动脉-左颈总动脉转流术联合支架象鼻治疗慢性Stanford B型主动脉夹层累及远端弓的临床经验  

Surgical treatment of chronic Stanford type B aortic dissection with distal aortic arch involvement using stented elephant trunk implantation combined with left subclavian artery to left common carotid artery bypass

作　　者：里程楠[1] 朱俊明[1] 齐瑞东[1] 杨祎[1] 于海 邢晓燕[1] 刘永民[1] 孙立忠[1] Li Chengnan;Zhu Junming;Qi Ruidong;Yang Yi;Yu Hai;Xing Xiaoyan;Liu Yongmin;Sun Lizhong(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beifing Aortic Disease Diagnosis and Treatment Center,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科北京市心肺血管疾病研究所北京市主动脉疾病诊疗中心,100029

出　　处：《中国医药》2018年第12期1818-1821,共4页China Medicine

基　　金：国家科技支撑计划(2015BAI12B03);国家卫生和计划生育委员会公益性行业科研专项(201402009)~~

摘　　要：目的回顾性总结采用左锁骨下动脉(LSCA)-左颈总动脉(LCCA)转流术联合支架象鼻植入治疗慢性Stanford B型主动脉夹层累及远端主动脉弓的临床经验。方法 2011年1月至2015年9月,26例慢性Stanford B型主动脉夹层累及远端主动脉弓患者在首都医科大学附属北京安贞医院心脏外科中心接受支架象鼻植入联合LSCA-LCCA转流术,对此部分患者临床资料行回顾性分析。其中男21例、女5例,平均年龄(48±10)岁。结果 26例患者中院内死亡2例(7. 7%)。同期手术包括Bentall+冠状动脉旁路移植术1例,主动脉瓣置换术+二尖瓣置换术+三尖瓣成形术1例,二尖瓣成形术1例。3例患者术后呼吸机辅助时间超过24 h,平均呼吸机辅助时间和住重症监护病房时间分别为(18±8)、(40±27)h。随访期间,1例患者于术后21个月死亡,死亡原因不明。随访期间1例患者行胸腹主动脉替换。结论应用支架象鼻植入术联合LSCA-LCCA转流术治疗慢性Stanford B型主动脉夹层累及远端弓,避免了介入治疗的相关并发症,获得了满意的临床效果。Objective To review the surgical experience of chronic Stanford type B aortic dissection with distal aortic arch involvement treated by stented elephant trunk implantation combined with left subclavian artery (LSCA)to left common carotid artery(LCCA)bypass.Methods From January 2011 to September 2015, clinical data of 26patients with chronic Stanford type B dissection with distal aortic arch involvement [21males, 5females,the mean age (48±10)years ]who underwent stented elephant trunk procedure with LSCA-LCCA bypass in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.Results In 26patients,there were 2in-hospital deaths (7.7%).Concomitant procedures included Bentall procedure + coronary artery bypass grafting in 1patient,replacement of aortic valve and mitral valve with plasty of tricuspid valve in 1patient,mitral valve plasty in 1patient.Ventilator support exceeded 24h in 3patients.The mean ventilator support time and the length of intensive care unit stay were (18±8)and (40±27)h,respectively. During follow-up,1patient died 21months after operation and the cause of death was unknown;1patient had thoracoabdominal aortic replacement.Conclusion Stented elephant trunk procedure with LSCA-LCCA bypass obtains satisfactory surgical results in chronic Stanford type B aortic dissection with distal aortic arch involvement.

关 键 词：慢性Stanford B型主动脉夹层 支架象鼻 左锁骨下动脉-左颈总动脉转流术 

分 类 号：R654[医药卫生—外科学]